Prevalence and recognition of geriatric syndromes in an outpatient clinic at a tertiary care hospital of Thailand.

Background: Geriatric syndromes are a series of clinical conditions in the elderly that do not fit into distinct categories. They affect the quality of life of a patient and are associated with disability. Objectives: This study determined the prevalence of geriatric syndromes in an Internal Medicine Outpatient setting. It compared the prevalence of each geriatric syndrome when using a comprehensive geriatric assessment versus the routine medical assessment. Methods: One hundred twenty elderly patients of the Internal Medicine Outpatient Clinic of Srinagarind Hospital Medical School were randomly reviewed between January 2008 and May 2010. Information on baseline characteristics and the presence of a geriatric syndrome was collected. Data for 50 patients assessed using a comprehensive geriatric assessment were reviewed prospectively and data for 70 patients assessed by a routine medical assessment were reviewed retrospectively. The prevalence for each syndrome was compared between two groups. Descriptive statistics and Chi-square test were used to analyze these outcomes. Results: The mean age and sex were not different between the two groups. Comparing the comprehensive geriatric assessment and routine medical assessment groups, there were, respectively, a prevalence of 30% vs. 1% for falls, 16% vs. 19% for dementia, 24% vs. 9% for urinary incontinence, 50% vs. 17% for functional dependency, and 22% vs. 14% for depression. Each syndrome was more prevalent with increasing age and in females. Falls (RR 2.79; 95% CI, 2.07-3.75), functional dependency (RR 2.24; 95% CI, 1.51-3.33) and urinary incontinence (RR 1.79; 95% CI, 1.18-2.70) had significantly higher prevalence in the comprehensive geriatric assessment group compared with the routine medical assessment group. Conclusions: Geriatric syndromes were highly prevalent in the elderly outpatient population. Under-recognition of these syndromes with routine medical assessments is common. Therefore, routine screening of these conditions by the comprehensive geriatric assessment is recommended.

Peripheral eosinophilia as an indicator of meningitic angiostrongyliasis in exposed individuals

The diagnosis of meningitic angiostrongyliasis (MA) is based on clinical criteria. A lumbar puncture is used as a diagnostic tool, but it is an invasive procedure. The blood eosinophil levels are also assessed and used in the diagnosis of this disease. We enrolled 47 patients with serologically proven MA and 131 controls with intestinal parasite infections. An absolute eosinophil count model was found to be the best marker for MA. An eosinophil count of more than 798 cells led to sensitivity, specificity, positive predictive and negative predictive values of 76.6 percent, 80.2 percent, 58.1 percent and 90.5 percent, respectively. These data support the use of testing for high blood eosinophil levels as a diagnostic tool for MA in individuals that are at risk for this disease.

The best criteria to diagnose metabolic syndrome in hypertensive Thai patients.

The metabolic syndrome (MS) is commonly found in clinical practice. There are many criteria to diagnose MS. The authors did a cross-sectional study to study the difference among the WHO criteria, the National Cholesterol Educational Program (NCEP) Adult Treatment Panel (ATP III), and the International Diabetes Foundation (IDF) in hypertensive patients. Between July and September 2005, 100 patients (62 women) treated at the hypertension clinic, Srinagarind Hospital were included. The WHO, NCEP A TP III and IDF criteria gave the diagnosis of MS in 37, 33, 60 cases, respectively. The IDF criteria had the significantly highest yield among those three criteria (p < 0.0001). Body mass index (BMI) was the only significant correlated with the diagnosis of MS by the IDF criteria (p-value = 0.04). It also had moderately positive correlated with waist circumference, WC (p < 0.0001, Pearson Correlation 0.58). At the cut point of BMI 23 kg/m2, we suggested the appropriate WC cut-point for Thai hypertensive men and women was 82.5 cm (32.5") and 79.5 cm (31.3"), respectively.

Clinical outcomes of patients with cardiogenic cerebral emboli in Srinagarind Hospital.

We retrospectively studied the functional outcomes and recurrence rates of patients 15 years and older in whom cardiogenic cerebral embolism was diagnosed at Srinagarind Hospital, Khon Kaen, Thailand, during the period of 1993-2002. Ninety patients were included in this study. Ages ranged from 16-80 years (mean 48.3 years). The majority of cardiac abnormalities were rheumatic heart diseases (with or without atrial fibrillation) and nonvulvular atrial fibrillation. At 3 months and 1 year after stroke, improvement in functional outcome (measured by RDS, motor strength, and GCS) were 74.4% and 55.6%, mortality rates of 13.3% and 16.7%; and recurrence rates of 8.9% and 16.7%, respectively. A GCS < 9 or motor power < or = 1 or RDS > or = 4 upon presentation were poor prognostic factors.

Communicating hydrocephalus as a complication of eosinophilic meningoencephalitis.

The authors reported an adult patient with communicating hydrocephalus in eosinophilic meningoencephalitis. He presented with localized peritonitis and then developed eosinophilic meningoencephalitis. Angiostrongylus cantonensis was the causative agent. This was confirmed by the positive serology test. His consciousness did not recover after supportive treatment. The MRI of the brain showed diffuse enlargement of the ventricular system two weeks after the diagnosis was made. The parameters for hydrocephalus were measured and were compatible with the Gyldensted's criteria.

Clinical manifestations of primary hyperthyroidism in the elderly patients at the out-patient clinic of Srinagarind Hospital.

The authors reviewed the outpatient charts diagnosed as hyperthyroidism at Srinagarind Hospital from June 1998-June 2004. The objective was to compare the clinical features of hyperthyroidism in patients older and younger than 60 years old. There were 922 cases enrolled, 84 cases (9.11%) were 60 years old and above. The female: male ratio was 3.4:1 and 4:1 and the mean ages were 64.2 +/- 3.7 and 37.4 +/- 11.2 years old in the elder and younger group, respectively. The common presentations were dyspnea (94.1, 96.5%), weight loss (93.8, 87.9%) and palpitation (83.3, 93.1%) in the elder and younger, respectively. The more significant clinical presentations in the elder group were atrial fibrillation, weakness and anorexia whereas exophthalmos, goiter, heat intolerance and hyperhidrosis were not as frequent. Thus, the classic presentations often lacked in the elder group. Therefore, unexplained AF, weakness and anorexia should not exclude hyperthyroidism even with paucity of typical clinical features.

Aspirin therapy as primary prevention in hypertensive patients at Srinagarind hospital.

Aspirin is now a useful therapy for both primary and secondary prevention for cardiovascular events especially in diabetic patients. Hypertension is also one of the major atherosclerotic risk factors. The authors studied the rate of aspirin use as primary prevention in hypertensive cases at Srinagarind Hospital, Khon Kaen University. There were 164 of 231 hypertensive patients who were aged over 50 years old and met the criteria for aspirin therapy with 2003 ESHs guideline. Only 18.9% (31 of 164 cases) were prescribed aspirin. The most common dose of aspirin was 60 mg/day which was lower than the suggested dose. Within one-year follow up, there was no serious side effects of the aspirin such as upper gastrointestinal bleeding.

Etiologies and treatment outcomes for out-patients with community-acquired pneumonia (CAP) at Srinagarind Hospital, Khon Kaen, Thailand.

Most patients with community-acquired pneumonia are treated as out-patients with empirical therapy, since initially the etiologic agent is unknown. We prospectively assessed the etiologies and treatment outcomes of pneumonia from February 2003 to 2004 at ambulatory clinics. Forty-four patients were included with a mean age of 49.2 (SD 18.2) years. The male to female ratio was 1:1.4. The incubation period was 6.9 (SD 4.4) days. Half of the patients were healthy. Asthma and COPD were common in patients with underlying diseases. The etiologic diagnosis was determined by a sputum culture and a serology test of paired serum samples. Hemo-culture produced no growth in any patients. Atypical pathogens and H. influenzae were the most common finding, each occurring in 31.8% of the patients followed by S. pneumoniae and H. parainfluenzae (27.3% each). Twenty-two patients were infected with multiple pathogens. C. pneumoniae was the most common co-infecting pathogen. Two of 12 S. pneumoniae isolates were penicillin resistant. Nine of 14 H. influenzae isolates were cotrimoxazole resistant and 8 of 14 were not sensitive to erythromycin. For H. parainfluenzae, 11 of 12 isolates were not sensitive to erythromycin, and 7 of 12 were not sensitive to cotrimoxazole. Oral antibiotics were prescribed as out-patient treatment. Forty patients (90.9%) improved, with symptoms-score improvement averaging 6.4 days. Four patients got worse and needed a change of antibiotics, the symptoms usually worsen within 3-5 days. We conclude that, antibiotics for CAP out-patients should cover atypical pathogens, H. influenzae, S. pneumoniae and H. parainfluenzae. If the clinical symptoms do not respond after 3-5 days of out-patient treatment, resistance or an unusual organism (eg B. pseudomallei) should be considered.

Wernicke's encephalopathy: report of a case.

A case of Wernicke's encephalopathy is reported. A 53-year-old alcoholic man was presented with acute confusion, upward gaze palsy of the left eye and gait ataxia for 5 days. The typical findings upon MRI of the brain showed multiple, scattered, small non-enhanced low signal intensity on T1WI, high signal intensity on T2WI involving at bilateral basal ganglias, and thalami, midbrain, pons, and periventricular regions with evidence of atrophic changes of brain and the mamillary bodies. After treatment with intravenous thiamine 100 mg/day, the left upward gaze palsy was fully recovered at the 8th day of treatment. The mental status and gait ataxia gradually improved.

Tuberculous radiculomyelitis (arachnoiditis) associated with tuberculous meningitis.

Abstract. A 17-year-old man who presented with progressive quadriparesis is reported. About 8 months prior to admission, he had miliary tuberculosis, and that improved with anti-tuberculous therapy. He had also developed tuberculous meningitis and tuberculous myelitis, respectively. He regularly took anti-tuberculous drugs until this illness. Neurological findings were compatible with cervical cord lesion. CSF analysis indicated a predominate lymphocytic pleocytosis with a high protein level and low sugar profile. MRI findings revealed a multi-loculated arachnoid cyst at C1-C3 level with pressure affecting the adjacent spinal cord and evidence of myelitis at C3-T1 level. Hemi-larminectomy and removal of the arachnoid cyst were performed, but without improvement. A CSF culture yielded M. tuberculosis, that was susceptible to anti-tuberculous drugs.